EG

Eosinophilic Gastritis

Eosinophilic gastritis (EG) is a rare disease in which a type of white blood cell, the eosinophil, causes injury and inflammation to the stomach.

When the inflammation and injury occurs in both the stomach and the small intestine, the disease is called eosinophilic gastroenteritis (EGE).

Both diseases are similar in how they affect the patient, how it is diagnosed, and how it is treated.

What causeseosinophilic gastritis?

The cause is unknown in many patients. Food and/or environmental allergies may play a role in the development of eosinophilic gastritis. People who have a personal or family history of allergic disorders may be at higher risk of developing EG.

What are the symptoms?

Common symptoms of eosinophilic gastritis include:

  • Vomiting, nausea
  • Difficulty feeding and/or gaining weight
  • Poor growth
  • Abdominal pain
  • Anemia (low blood counts)
  • Fatigue

Who is affected?

Eosinophilic gastritis can affect both adults and children. Both males and females are affected, with males slightly more than females. EG is often seen in conjunction with other forms of eosinophilic disease.

Most people who have EG also have other allergic disorders (eczema, hay fever, asthma) and/or have food intolerances or allergies, especially children. A smaller percentage of sufferers may also have a family member with a similar eosinophilic disorder.

How is eosinophilic gastritis diagnosed?

Eosinophilic gastritis is diagnosed by an upper endoscopy where a small tube is directed through the esophagus, stomach, and part of the small intestine. This tube allows the doctor to see any visual changes in the tissue, such as erosions or irritated areas of the stomach. The doctor will take small tissue samples (biopsies).

The biopsies are examined under a high-powered microscope to see the small cell structures. If eosinophils are present in the sample, the pathologist will count how many are visible. The stomach typically has low numbers of eosinophils present, and there are no consensus guidelines to suggest a threshold for what is considered elevated. Therefore, diagnosis is based on clinical symptoms, visual evidence in the endoscopy, the pathology report, and how well the patient responds to therapy.

High levels of eosinophils in the stomach may also be caused by other conditions such as helminthic infections (e.g., pin worms, hookworms), inflammatory bowel disease, autoimmune disease, celiac disease, drug reactions, and in association with hypereosinophilic syndrome.

How is eosinophilic gastritis treated?

There are no consensus guidelines for the treatment of eosinophilic gastritis.

The goal of the treatment is to reduce the inflammation and damage caused by the eosinophils.

Your doctor may suggest allergy testing to help determine if a specific allergen is triggering EG. Once allergens have been identified or ruled out, there are two main therapies used to manage EG:

Dietary Therapy – Dietary therapy involves removing suspected causative foods; eliminating common food allergens such as milk, wheat, soy, fish, shellfish, peanuts, tree nuts, and eggs; or removing food entirely from the diet and relying on specialized formula for nutrition.

For some patients, especially infants, only a few foods are identified as causing the problem (typically milk and/or soy), and once those foods are removed from the diet, EG resolves.

Medications – Medications such as systemic steroids (prednisone) or other anti-inflammatory medicines may be prescribed. If the patient is iron deficient, iron supplements may also be recommended.

To evaluate how you are responding to treatment, periodic endoscopies with biopsies will be performed.

What is the prognosis?

Prognosis of EG depends on the response to treatment. EG is chronic with periods of activity and periods of apparent remission.

Frequently Asked Questions

Q: Are there consensus guidelines for EG?

A: Not at the current time, in part because so few patients have EG. The American Academy of Asthma, Allergy, and Immunology, and the leading gastroenterology groups, have created a bi-annual symposium on

eosinophilic digestive disorders, which may lead to future clinical treatment guidelines and management. (For more information about The International Gastrointestinal Eosinophil Researchers: http://tiger-egid.cdhnf.org/)

The value of the consensus statement on eosinophilic esophagitis is that it came from existing medical literature rather than just opinion.

Comparable data for EG does not exist, and most literature is limited to case studies (very small numbers). Research is being done, but it is difficult to get enough patients. Given the apparent increase in cases noted around the country by many physicians, it is likely that more research findings will develop in the next few years.

Q: Can the treatment info on EoE be applied to EG?

A: The global approach to treating all eosinophil-associated gastrointestinal disease (EGID) is to reduce inflammation. The principles of treatment are the same between EGID subsets. Continued monitoring for development of inflammatory bowel diseases should always be considered since some treatments for eosinophilic gastroenteritis can also mask the development of inflammatory bowel diseases, such as ulcerative colitis or Crohn’s.

Q: Should I be concerned about scarring from repeated scopes and biopsies?

A: The risk of scarring from endoscopy itself is virtually zero. The scope itself does not cause trauma under normal circumstances, and the size of the biopsies are very small. There is a small risk associated with repeated anesthesia; and there is always risk with any procedure.

Q: Are EGIDs deadly?

A: EGIDs are generally not immediately life threatening, though they have a significant impact on quality of life. Complications from EGIDs can develop that may become deadly without intervention, such as severe malnutrition, dehydration, or food impaction due to structural changes in the esophagus. These issues are more likely to have significant impacts on infants and young children unlike teens/adults who can describe difficulties more easily.

Other Resources

References

Ko HM, Morotti RA, Yershov O, Chehade M. Eosinophilic gastritis in children: clinicopathological correlation, disease course, and response to therapy Am J Gastroenterol. 2014 Aug;109(8):1277-85. doi: 10.1038/ajg.2014.166. Epub 2014 Jun 24.

Caldwell JM
Collins MH
Stucke EM
Putnam PE
Franciosi JP
Kushner JP
Abonia JP
Rothenberg ME
Histologic eosinophilic gastritis is a systemic disorder associated with blood and extragastric eosinophilia, TH2 immunity, and a unique gastric transcriptome
J Allergy Clin Immunol.

Caldwell JM, Collins MH, Stucke EM. Histologic eosinophilic gastritis is a systemic disorder associated with blood and extragastric eosinophilia, TH2 immunity, and a unique gastric transcriptome. J Allergy Clin Immunol. 2014 Sep 8. pii: S0091-6749(14)01014-8. doi: 10.1016/j.jaci.2014.07.026. [Epub ahead of print]

© American Partnership for Eosinophilic Disorders (APFED) 2004-2016 All rights reserved. Content may not be reproduced in whole or in part without express written consent from APFED. Contact us at mail@apfed.org. Contributors: Wendy Book, MD; Harvey Leo, MD; Mary Jo Strobel; Kelly Morris